DSM-5 defines borderline personality disorder

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Tania Traylor

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Discussion Post week 10

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Discussion Post 10

The patient is a 15-year-old Native American who has been cutting himself for ten months and had two previous suicide attempts. His grades have declined recently; he reports that he is pansexual and dates a male peer for the past two months. He is not sexually active. He denies any alcohol but did try marijuana several months ago. He lives with his mother and brother, but his father has limited contact with since the divorce when he was five years of age. He is disrespectful to his mother. The client reports he had suicidal ideation yesterday. He does report interpersonal conflict with close friends.

Post an explanation of the most likely DSM-5 diagnosis for the client in the case study. Be sure to link those behaviors to the criteria in the DSM-5

I think the patient has a borderline personality disorder (BDP). DSM-5 defines borderline personality disorder (301.83) as having problems with people in their life like family and friends (APA, 2013). Diagnosing BDP has five or more symptoms, and the client has the following:

-trying to prevent abandonment, whether real or not real.

-Shaky relationships with family, friends, and or significant other.

-Uncertain self-image

-the client has two problems that could be self-damaging

-several suicidal attempts, or self-mutilating behavior

The client has the above symptoms of BDP. He displays of anger are results of abandonment issues (APA, 2013). He is having difficult relationship issues with everyone he is close to and even has lost close friends. He has an unstable self-image due to feelings of abandonment, sexual identity, value, and loss of close friends (APA, 2013). He has recently engaged in reckless behavior like marijuana use, going out with friends, spending money, and declining grades. He has had two suicide attempts and self-mutilating behavior.

Explain group therapeutic approaches you might use with this client. Explain expected outcomes for the client based on these therapeutic approaches

The right approach for this client is a schema group therapy. A psychotherapy group made up of adolescents like himself would give the group a family-like atmosphere (Wetzelaer et al., 2014). The group could help the client feel like he was part of this “family” and give him a sense of belonging (Wetzelaer et al., 2014). The client probably would be more receptive to the other teenager’s feedback.There is some hesitancy to diagnose adolescents with BPD (Sharp & Fonagy, 2015). I think that early intervention is the key to adolescents. Early intervention was introducted by Chanen & McCutcheon for fifteen years, and their program is called Helping Young People Early (HYPE) (Sharp & Fonagy, 2015). It is a program for young people age 15-25 years of age, and they have to have two of the symptoms of BPD (Sharp & Fonagy, 2015). Another program for younger teens diagnosed with BPD is the Dutch Emotion Regulation training (ERT). It is a 20-week group treatment that uses cognitive-behavioral and skills training (Sharp & Fonagy, 2015). The outcome is to decrease the symptoms of BPD. Although there are no universal precautions for BPD, there are preventions that could work. The child or adolescent needs to be put in group therapy for early interventions. Chanen & McCutcheon believe that only two symptoms of BPD need to noted so for early intervention for the clients.

Finally consider legal and ethical implications of counseling children and adolescent clients with psychiatric disorders

The ethical considerations of dealing with counseling children and adolescents are the importance of dealing with their legal guardians and obtaining the guardian authorization. One of the principles in dealing with children and adolescents is not harming and making sure the interventions are for the child/teen and not for adults (Mercer, 2017). Research on children and adolescents needs to be approached cautiously because of the confidentiality and disclosure aspect (Hiriscau, 2014). The main point is that children and adolescent are not adults and should not be treated as such.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disordres

(5th ed.). Washington, DC: Author.

Hiriscau, I., Stingelin-Giles, N., Stadler, C., Schmeck, K., & Reiter-Theil, S. (2014). A right to

confidentiality or a duty to disclose? Ethical guidance for conducting prevention research

with children and adolescents. European Child & Adolescent Psychiatry, 23(6), 409–416.

https://doi-org.ezp.waldenulibrary.org/10.1007/s00787-014-0526-y

Mercer, J. (2017). Evidence of Potentially Harmful Psychological Treatments for Children and

Adolescents. Child & Adolescent Social Work Journal, 34(2), 107–125. https://doi-

org.ezp.waldenulibrary.org/10.1007/s10560-016-0480-2

Sharp, C., & Fonagy, P. (2015). Practitioner Review: Borderline personality disorder in

adolescence – recent conceptualization, intervention, and implications for clinical

practice. Journal of Child Psychology & Psychiatry, 56(12), 1266–1288. https://doi-

org.ezp.waldenulibrary.org/10.1111/jcpp.12449

Wetzelaer, P., Farrell, J., Evers, S. M. A. ., Jacob, G. A., Lee, C. W., Brand, O., van Breukelen,

G., Fassbinder, E., Fretwell, H., Harper, R. P., Lavender, A., Lockwood, G., Malogiannis, I.

A., Schweiger, U., Startup, H., Stevenson, T., Zarbock, G., & Arntz, A. (2014). Design of an

international multicentre RCT on group schema therapy for borderline personality

disorder. BMC Psychiatry, 14. https://doi-org.ezp.waldenulibrary.org/10.1186/s12888-014-

0319-3

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